Individual
JOHN BRYAN STUPPY
Active
Individual
JOHN BRYAN STUPPY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW, LADAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3419
NM
1041C0700X
Clinical Social Worker
Primary
I-6160
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53052552
—
NM
05
—
60759364
—
NM
Enumeration date
09/13/2005
Last updated
01/17/2008
Update your record
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